Many prostate cancer experts in the United States have condemned the recommendation by the US Preventive Services Task Force (USPSTF), announced last week, against the routine screening of healthy men with the prostate-specific antigen (PSA) test

The draft form of the recommendation, published online October 7 in the Annals of Internal Medicine, is now open for comments. In it, the USPSTF extended its recommendation against PSA screening to all men (it had previously specified men older than 75 years), after it found little evidence of benefit in terms of prostate cancer mortality, but plenty of evidence of potential harm. The recommendation has a "D" rating, which signifies that "there is moderate or high certainty that the service has no benefit or that the harms outweigh the benefits."

"This is the wrong message at this point in time," said Philip Kantoff, MD, director of Dana-Farber's Lank Center for Genitourinary Oncology in Boston, Massachusetts.

"The whole issue of PSA-based screening is complex. It involves multiple steps and multiple decision points. The blanket statement saying that PSA-based screening is of no value is the wrong message right now," he noted in a statement.

"There is no question that we need to be more careful with whom we screen, and we need to recognize that not every man needs to be screened," Dr. Kantoff explained. He acknowledged that the PSA test has issues with specificity and sensitivity, but he concludes that it is a useful screening tool when it is used appropriately.

This is a stance similar to the one taken by the American Urological Association (AUA), which has long emphasized that the PSA test needs to be considered alongside other data, and that, when interpreted appropriately, it offers "important information." The current clinical guidelines of the AUA support the use of the PSA test, although they are due to be updated soon.

The AUA reacted immediately to the news, warning that the recommendation might "ultimately do more harm than good to the many men at risk for prostate cancer, both here in the United States and around the world."

"The dueling recommendations from the USPSTF and the AUA — along with passionate responses on all sides — are probably only going to further confuse men," said Marc Garnick, MD, a clinical professor of medicine at Harvard Medical School with an oncology practice at Beth Israel Deaconess Medical Center in Boston.

I plan on continuing with my annual PSA screening at my annual physical exam next month. So far, the test has been at a low level for me and I have not had to confront the issues raised by these dueling experts.